Our first line of defense

An expert on public health talks about what America needs to fight a bioterrorist attack, why we don't have it and how stocking up on cipro is a danger to everyone.

By Laura Miller

Oct. 17, 2001 | Fears over the (still very small) number of anthrax cases apparently caused by exposure to contaminated mail have many Americans rushing to their doctors in search of prescriptions. Pulitzer Prize-winner Laurie Garrett, author of the acclaimed "Betrayal of Trust: The Collapse of Global Public Health" and a reporter for Newsday, finds the mad dash for ciprofloxacin as troubling as the threat of bioterrorism itself. Our public health system, we're told, is our most important line of defense against germ warfare, but in her book (published last year) Garrett observed that the system, in its current state, is "a wreck." Will the government's plan for fighting an anthrax outbreak work? Salon telephoned Garrett at her New York office to get her perspective on the crisis.

In the many articles I've read about the possible remedies for a biological weapons attack, the mantra has been that people can't respond or protect themselves effectively on an individual basis -- it has to be done on the level of the public health system. What exactly does that mean?

Let's back up a second and ask, what are we doing? Our government is buying ciprofloxacin, and we're buying tons of it. We're buying so much cipro that Bayer in Germany has to reopen a long-shutdown factory to accommodate the American demand. That seems to be the primary thrust of this administration's commitment at this point.

In my book, purchasing massive quantities of ciprofloxacin is a medical response, not a public health response. The appropriate public health response, it seems to me, would be to look for the most frontline primary antibiotic that appears to be effective. As far as we can tell, the stuff that's floating around right now in people's envelopes is completely penicillin-susceptible. It would make a whole lot more sense and it would save hundreds of millions of dollars -- not to mention you wouldn't be breeding broad-spectrum, drug-resistant bacterial disease in millions of Americans -- if you use penicillin. Why in the world are we going for the world's most expensive, broad-spectrum, highly resistance-prone antibiotics?

Why do you think that is?

Because the response of a physician to the situation is: When in doubt, go for your bazooka even if a BB gun will work. That's appropriate when you're thinking about the individual, but when you're thinking about the population as a whole, what's appropriate to the individual is probably not appropriate on a population-wide basis. Using cipro is first of all highly expensive and second of all highly likely to breed resistance. What worries me is that if we wind up spending something on the order of $1.5 billion on ciprofloxacin alone -- and that's just direct federal-level expenditure not including state-, individual- and insurance plan-level expenditure -- we could well go over the $4 billion mark on ciprofloxacin in the next two weeks. Is that the appropriate way to spend $4 billion that the public health structure has been starving for for more than a decade?

If the public health structure has been starving for funds for so long, is it in any kind of shape to respond to a serious biological attack or catastrophe?

We've been preparing, but only on the level of a handful of highly committed and already convinced individuals who have staged various war game scenarios, tried to enhance the state of readiness, tried to increase the level of concern. The best-prepared city in the nation was New York, and we can see even with this very tiny number of cases -- a handful, literally -- there have been a lot of mistakes made. The fact that police officers went in and sniffed it is ... that's out there.

Next page: "Tremendous holes in the safety net"